Medical Billing and Coding: The Need to be HIPAA Compliant

Medical Billing and Coding: The Need to be HIPAA Compliant

Medical billing and coding is a complex field and the Health Insurance Portability and Accountability Act (HIPAA), which is designed to help ensure patient privacy, has made it even more complicated, as medical records and data associated with patients must remain confidential.

In 2012, the pilot HIPPA auditing program was implemented. At that time, 115 organizations were closely audited. The audits, which were overseen by the Department of Health and Human Services’ Office for Civil Rights (OCR), found what is considered to be a major problem across the board for all who were scrutinized: a lack of risk analysis. That systemic problem led to specific breaches in security that, in essence, were often unrecognized and/or unmitigated by the offending entity.

Pilot Program Results

Breaches in security were common and included improper disclosure of information and refusal of patients attempting to access their data. Through the pilot program, the OCR levied noncompliance fines totaling $4.5 million. That money was used to constitute part of the budget for the permanent auditing program, which went into effect in 2014.

Medical Billing and Coding Concerns

Records that are kept by medical practices can be compromised in many ways. It’s important that healthcare professionals keep all of their records safe from any intrusion and confidential. Many medical practices find HIPAA regulations to be daunting and complex.

Working with a company that can properly manage all aspects of medical billing and coding, administrative functions, and operational functions in accordance with HIPAA is essential to the wellbeing of a healthcare practice.

Permanent HIPAA Enforcement

In 2014, permanent enforcement efforts, overseen by the OCR and conducted by a private contractor or contractors, began. This time, many more organizations are being audited, and it’s expected that fines for noncompliance will be harsher.

Efforts, as they were in the pilot program, are geared towards checking for compliance with HIPAA’s Privacy, Security, and Breach Notification Rules. Under the permanent program, there are bound to be fluctuations and changes in what auditors are specifically concerned with, depending upon what they find in the field.

For organizations that face such audits, which can result in costly fines when noncompliance is discovered, the stakes are high. This is especially the case with a program such as HIPPA, which is information, data, and document heavy.

There is the added dilemma of vulnerability in that those being audited may discover that they are being investigated for noncompliance issues that had not been previously an aspect of other audits. In other words, as time goes on it will be difficult for healthcare providers and others under HIPPA to know what to prepare for in an audit.

Being in Total Compliance

The best way to be ready for an audit is to be in total compliance. The best way to do that is to work with solutions providers who understand HIPPA compliance and who possess an in-depth understanding of HIPPA violations. HIPPA compliance, in relationship to all data, including those related to medical billing and coding, is important to the financial health of one’s practice.

HIPPA audits can result in huge fines, as violations can mount up if they are systemic. In such cases, each violation is treated individually, which means you’re fined individually for each breech in compliance. Healthcare providers are advised to work with a company that can make sure that all HIPAA related aspects, including medical billing and coding, are completely compliant.

MPMR is one of the best medical billing companies in the nation, with decades of experience in top medical billing and coding along with practice management consulting. MPMR helps both physician practices along with ambulatory surgery centers increase their revenues and streamline operations.

Call today for a complimentary consult to see how MPMR can help you!

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